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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 331, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 211, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 128, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 47, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 25)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 5)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 60)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 343, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 307, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 53, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 38, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 191, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 3)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 10)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 162, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 157, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Ophthalmology
  [SJR: 2.803]   [H-I: 148]   [54 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9394
   Published by Elsevier Homepage  [3043 journals]
  • One- Versus Two-Muscle Surgery for Presumed Unilateral Fourth Nerve Palsy
           Associated With Moderate Angle Hyperdeviations
    • Authors: David L. Nash; Sarah R. Hatt; David A. Leske; Laura May; Erick D. Bothun; Brian G. Mohney; Michael C. Brodsky; Jonathan M. Holmes
      Pages: 1 - 7
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): David L. Nash, Sarah R. Hatt, David A. Leske, Laura May, Erick D. Bothun, Brian G. Mohney, Michael C. Brodsky, Jonathan M. Holmes
      Purpose To compare 1-muscle vs 2-muscle surgery for moderate-angle hyperdeviations owing to presumed unilateral fourth nerve palsy. Design Retrospective chart review. Methods Seventy-three patients (aged 5–86 years) underwent either 1- or 2-muscle surgery at our institution for moderate hyperdeviation owing to presumed unilateral fourth nerve palsy, measuring 14–25 prism diopters (PD) in straight-ahead gaze at distance fixation. Six-week and 1-year motor success was defined as zero vertical deviation or 1–4 PD undercorrection at distance, overcorrection as any reversal of hypertropia, and undercorrection as >4 PD. Diplopia success was defined as no diplopia, or only rarely for distance straight ahead and reading. Results Twenty-eight patients underwent 1-muscle surgery, and 45 patients underwent 2-muscle surgery. Motor success was similar (64% vs 67%, P > .99 at 6 weeks; 47% vs 55%, P = .8 at 1 year, n = 46), but there were more undercorrections at 6 weeks with 1-muscle surgery (36% vs 16%, P = .09) and more overcorrections at 6 weeks with 2-muscle surgery (0% vs 18%, P = .02). Diplopia success was also somewhat similar between 1- and 2-muscle surgery at 6 weeks (73% vs 60%, P = .5) and 1 year (45% vs 59%, P = .5). Conclusion For moderate-angle hyperdeviations owing to presumed unilateral fourth nerve palsy, there appears no clear advantage of 2-muscle surgery for motor outcomes. Diplopia success was similar between 1- and 2-muscle surgery, owing to a greater number of less symptomatic undercorrections with 1-muscle surgery and a smaller number of more symptomatic overcorrections with 2-muscle surgery.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.06.030
      Issue No: Vol. 182 (2017)
       
  • Conjunctival Autograft Versus Amniotic Membrane Transplantation for
           Treatment of Pterygium: Findings From a Cochrane Systematic Review
    • Authors: Elizabeth Clearfield; Barbara S. Hawkins; Irene C. Kuo
      Pages: 8 - 17
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): Elizabeth Clearfield, Barbara S. Hawkins, Irene C. Kuo
      Purpose To summarize key findings from a systematic review of the effectiveness and risks of conjunctival autograft (CAG) compared with amniotic membrane transplant (AMT) for pterygium. Design Cochrane systematic review. Methods We included only randomized controlled trials (RCTs) in which CAG and AMT had been compared for primary or recurrent pterygia. The primary outcome was recurrence of pterygium ≥1 mm onto the cornea by 3 and 6 months post surgery. We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis. Results Twenty RCTs with 1866 participants (1947 eyes) were included. Pterygium recurrence 6 months after surgery ranged from 3.3% to 16.7% in the CAG group and 6.4% to 42.3% in the AMT group based on data from 1021 eyes in 10 RCTs. Estimated risk ratios from meta-analysis indicated that CAG-treated eyes had a 47% lower risk of recurrence 6 months after surgery compared with the AMT group (RR, 0.53, 95% confidence interval [CI], 0.33–0.85). For 96 eyes with recurrent pterygium, the risk of recurrence 6 months after CAG was reduced by 55% compared with AMT (risk ratio [RR], 0.45, 95% CI, 0.21–0.99). Three-month recurrence rates were similar for CAG and AMT based on data from 538 eyes (6 RCTs). Conclusions CAG was more effective than AMT to prevent pterygium recurrence by 6 months post surgery, especially in recurrent pterygia. CAG-treated eyes had half the recurrence rates of AMT-treated eyes. Future RCTs should assess changes in patient-reported outcomes (symptoms, cosmesis) and visual acuity, and evaluate effects of surgical variations.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.07.004
      Issue No: Vol. 182 (2017)
       
  • The Prevalence of Chronic Conditions and Poor Health Among People With and
           Without Vision Impairment, Aged ≥65 Years, 2010–2014
    • Authors: John E. Crews; Chiu-Fang Chou; Swathi Sekar; Jinan B. Saaddine
      Pages: 18 - 30
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): John E. Crews, Chiu-Fang Chou, Swathi Sekar, Jinan B. Saaddine
      Purpose To examine the prevalence of 13 chronic conditions and fair/poor health among people aged ≥65 years in the United States with and without vision impairment. Design Cross-sectional study from the 2010–2014 National Health Interview Survey. Methods We examined hypertension, heart disease, high cholesterol, stroke, arthritis, asthma, chronic obstructive pulmonary disease, cancer, weak/failing kidneys, diabetes, hepatitis, depression, and hearing impairment. We used logistic regression to show the association between vision impairment and chronic conditions and the association between vision impairment and poor health for those with chronic conditions. Results People aged ≥65 years with vision impairment reported greater prevalence of chronic conditions compared to people without vision impairment. After controlling for covariates (age, sex, education, race, smoking, physical activity, and obesity), people with vision impairment were more likely than those without to report chronic conditions (hypertension: OR [odds ratio] 1.43; heart disease: OR 1.68; high cholesterol: OR 1.26; stroke: OR 1.99; arthritis; OR 1.71; asthma: OR 1.56; chronic obstructive pulmonary disease: OR 1.65; cancer: OR 1.23; weak/failing kidneys: OR 2.29; diabetes: OR 1.56; hepatitis: OR 1.30; depression: OR 1.47; hearing impairment: OR 1.91) (all P < .05). Among older people with chronic conditions, those with vision impairment and chronic conditions compared to people without vision impairment and chronic conditions were 1.66–2.98 times more likely to have fair/poor health than those without vision impairment (all P < .05). Conclusion Higher prevalence of chronic conditions is strongly associated with vision impairment among the older people and poor health is strongly associated with vision impairment and chronic conditions.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.06.038
      Issue No: Vol. 182 (2017)
       
  • Postreceptor Neuronal Loss in Intermediate Age-related Macular
           Degeneration
    • Authors: Enrico Borrelli; Nizar Saleh Abdelfattah; Akihito Uji; Muneeswar Gupta Nittala; David S. Boyer; SriniVas R. Sadda
      Pages: 1 - 11
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): Enrico Borrelli, Nizar Saleh Abdelfattah, Akihito Uji, Muneeswar Gupta Nittala, David S. Boyer, SriniVas R. Sadda
      Purpose To investigate the relationship between ganglion cell complex (GCC) thickness and photoreceptor alterations in eyes with intermediate age-related macular degeneration (AMD). Design Retrospective case-control study. Methods We collected data from 68 eyes with intermediate AMD from 68 patients with spectral-domain optical coherence tomography (SDOCT) imaging. A control group of 50 eyes from 50 healthy subjects was included for comparison. Our main outcome measures for comparison between groups were (1) the average and minimum GCC thickness and (2) the “normalized” reflectivity of the ellipsoid zone (EZ) en face image. Results The average and minimum GCC thicknesses were thinner in AMD patients (69.54 ± 9.30 μm and 63.22 ± 14.11 μm, respectively) than in healthy controls (78.57 ± 6.28 μm and 76.28 ± 6.85 μm, P < .0001 and P < .0001, respectively). Agreement was found to be excellent in the “normalized” EZ reflectivity assessment (intraclass correlation coefficient = 0.986, coefficient of variation = 1.11). The EZ “normalized” reflectivity was 0.67 ± 0.11 in controls and 0.61 ± 0.09 in the AMD group (P = .006). In univariate analysis, EZ “normalized” reflectivity was found to have a significant direct relationship with average (P < .0001) and minimum (P < .0001) GCC thickness in AMD patients, but not in controls (P = .852 and P = .892, respectively). Conclusions Eyes with intermediate AMD exhibit GCC thinning, as well as a reduced EZ “normalized” reflectivity, and these parameters are correlated. This study supports the concept of postreceptor retinal neuronal loss as a contributor to retinal thinning in intermediate AMD.

      PubDate: 2017-07-10T10:06:31Z
      DOI: 10.1016/j.ajo.2017.06.005
      Issue No: Vol. 181 (2017)
       
  • Optical Coherence Tomography Angiography of Macular Features After Proton
           Beam Radiotherapy for Small Choroidal Melanoma
    • Authors: Alexandre Sellam; Florence Coscas; Livia Lumbroso-Le Rouic; Rémi Dendale; Marco Lupidi; Gabriel Coscas; Laurence Desjardins; Nathalie Cassoux
      Pages: 12 - 19
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): Alexandre Sellam, Florence Coscas, Livia Lumbroso-Le Rouic, Rémi Dendale, Marco Lupidi, Gabriel Coscas, Laurence Desjardins, Nathalie Cassoux
      Purpose To describe the macular features of patients treated with proton beam therapy for choroidal melanoma (CM), using optical coherence tomography angiography (OCTA). Design Retrospective case-control study. Methods This study included patients treated with proton beam radiotherapy (PBR) for a small CM. Only patients who had received 100% of the dose of 60 Gy external beam radiation to the macular area were included in the analysis. All the patients had undergone a full ophthalmologic examination, including visual acuity, optical coherence tomography B-scan, and OCTA. Qualitative and quantitative vascular features of the retinal plexus and the choriocapillaris were analyzed on OCTA and compared with those in healthy subjects matched on age and sex. Results Thirty-seven patients had undergone an OCTA after PBR for a small CM. Seventeen patients (9 men and 8 women) were included. The mean age of the patients was 56.6 years (range, 28-86). At presentation, the mean tumor thickness was 3.39 mm (range, 1.3-7.0 mm). The mean follow-up duration was 35.8 months (range, 11-72 months). Thirteen patients (76.5%) had a clinical radiation maculopathy; 8 patients (47.1%) had macular cysts on OCT-B scan. All patients (100%) had abnormalities on OCTA. Some “signal void” spots were detected at the level of the choriocapillaris in 15 patients (88.2%). The mean vascular density (regarding the full retina) was significantly lower in the patients treated with PBR than in healthy subjects (P < .0001). Conclusion Patients treated with PBR for CM (with 100% of the dose given to the macula) present major changes at both plexuses but also a vascular rarefaction of the choriocapillaris.

      PubDate: 2017-07-10T10:06:31Z
      DOI: 10.1016/j.ajo.2017.06.008
      Issue No: Vol. 181 (2017)
       
  • The Auckland Cataract Study II: Reducing Complications by Preoperative
           Risk Stratification and Case Allocation in a Teaching Hospital
    • Authors: Bia Z. Kim; Dipika V. Patel; James McKelvie; Trevor Sherwin; Charles N.J. McGhee
      Pages: 20 - 25
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): Bia Z. Kim, Dipika V. Patel, James McKelvie, Trevor Sherwin, Charles N.J. McGhee
      Purpose To assess the effect of preoperative risk stratification for phacoemulsification surgery on intraoperative complications in a teaching hospital. Design Prospective cohort study. Methods Prospective assessment of consecutive phacoemulsification cases (N = 500) enabled calculation of a risk score (M-score of 0–8) using a risk stratification system. M-scores of >3 were allocated to senior surgeons. All surgeries were performed in a public teaching hospital setting, Auckland, New Zealand, in early 2016. Postoperatively, data were reviewed for complications and corrected distance visual acuity (CDVA). Results were compared to a prospective study (N = 500, phase 1) performed prior to formal introduction of risk stratification. Results Intraoperative complications increased with increasing M-scores (P = .044). Median M-score for complicated cases was higher (P = .022). Odds ratio (OR) for a complication increased 1.269 per unit increase in M-score (95% confidence interval [CI] 1.007–1.599, P = .043). Overall rate of any intraoperative complication was 5.0%. Intraoperative complication rates decreased from 8.4% to 5.0% (OR = 0.576, P = .043) comparing phase 1 and phase 2 (formal introduction of risk stratification). The severity of complications also reduced. A significant decrease in complications for M = 0 (ie, minimal risk cases) was also identified comparing the current study (3.1%) to phase 1 (7.2%), P = .034. There was no change in postoperative complication risks (OR 0.812, P = .434) or in mean postoperative CDVA (20/30, P = .484) comparing current with phase 1 outcomes. Conclusion A simple preoperative risk stratification system, based on standard patient information gathered at preoperative consultation, appears to reduce intraoperative complications and support safer surgical training by appropriate allocation of higher-risk cases.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.06.014
      Issue No: Vol. 181 (2017)
       
  • Conjunctival Goblet Cell Density Following Cataract Surgery With
           Diclofenac Versus Diclofenac and Rebamipide: A Randomized Trial
    • Authors: Kumiko Kato; Kensaku Miyake; Nagako Kondo; Sayaka Asano; Junko Takeda; Akiko Takahashi; Yuko Takashima; Mineo Kondo
      Pages: 26 - 36
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): Kumiko Kato, Kensaku Miyake, Nagako Kondo, Sayaka Asano, Junko Takeda, Akiko Takahashi, Yuko Takashima, Mineo Kondo
      Purpose To determine the effects of topical diclofenac or betamethasone with concomitant application of topical rebamipide on the conjunctival goblet cell density in eyes after cataract surgery. Design Randomized clinical trial. Participants Eighty patients who were scheduled for cataract surgery. Methods Patients were randomized into 4 groups according to the postoperative topical drugs to be given; Group A, diclofenac alone; Group B, diclofenac and rebamipide; Group C, betamethasone alone; and Group D, betamethasone and rebamipide. Impression cytology was performed before and at 1 month after the surgery, and the mean density of goblet cells was determined. Results The mean (± SD) density of goblet cells before the surgery in Group A was 257.0 ± 188.7 cells/mm2, and it decreased significantly to 86.5 ± 76.7 cells/mm2 at 1 month after the surgery (P = .002). In Group B, the goblet cell density was not statistically different between before (238.5 ± 116.6 cells/mm2) and at 1 month after the surgery (211.3 ± 184.4 cells/mm2, P = .55). In Groups C and D, the mean density of goblet cells was decreased at 1 month after the surgery, but the decreases were not significant (P = .11 and P = .52, respectively). Conclusion After cataract surgery with postoperative topical diclofenac, the conjunctival goblet cell density was significantly reduced, and this reduction was blocked by the concomitant use of topical rebamipide. These results suggest that the concomitant use of topical rebamipide with nonsteroidal anti-inflammatory drugs is beneficial, especially in cases with postoperative dry eyes.

      PubDate: 2017-07-19T10:24:54Z
      DOI: 10.1016/j.ajo.2017.06.016
      Issue No: Vol. 181 (2017)
       
  • Impacts of Implantable Collamer Lens V4c Placement on Angle Measurements
           Made by Optical Coherence Tomography: Two-Year Follow-up
    • Authors: José Ignacio Fernández-Vigo; Ana Macarro-Merino; Cristina Fernández-Vigo; José Ángel Fernández-Vigo; Lucía De-Pablo-Gómez-de-Liaño; Cristina Fernández-Pérez; Julián García-Feijóo
      Pages: 37 - 45
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): José Ignacio Fernández-Vigo, Ana Macarro-Merino, Cristina Fernández-Vigo, José Ángel Fernández-Vigo, Lucía De-Pablo-Gómez-de-Liaño, Cristina Fernández-Pérez, Julián García-Feijóo
      Purpose To determine iridocorneal angle changes produced after 2 years of implantable collamer lens (ICL) V4c (STAAR Surgical AG, Nidau, Switzerland) placement by Fourier-domain optical coherence tomography (FD-OCT). Design Prospective interventional case series. Methods In 54 eyes of 27 myopic subjects FD-OCT iridocorneal angle measurements were made before and 1 month, 3 months, 1 year, and 2 years after ICL implant. Trabecular-iris angle (TIA), angle opening distance 500 μm from the scleral spur (AOD500), and iridotrabecular contact length (TICL) were compared among these time points and the nasal, temporal, and inferior quadrants. Results Preoperative TIAs were 49.5 ± 8.7, 48.3 ± 9.6, and 49.1 ±8.6 degrees for the nasal, temporal and inferior quadrants (P < .001). Corresponding values were 29.9 ± 10.4, 28.4 ± 10.8, and 28.8 ± 9.7 degrees at 1 month and 27.3 ± 8.8, 26.8 ± 8.1, and 28.9 ± 7 degrees at 2 years of follow-up, indicating angle narrowing of 39%-45% and no further narrowing beyond 1 month in the nasal (P = .133), temporal (P = .376), and inferior (P = 1.000) quadrants. Trabecular-iris contact (TIC) was observed in 8 eyes of 8 subjects, mostly only in the temporal quadrant. Mean TICL failed to vary during follow-up (307 ± 288 μm at 3 months and 225 ± 142 μm at 2 years, P = .159). Conclusions In response to ICL V4c implant, considerable angle narrowing was detected at 1 month but this narrowing remained stable at 2 years. In the 8 cases of TIC, no progression of contact was observed beyond 3 months postimplant.

      PubDate: 2017-07-26T10:31:33Z
      DOI: 10.1016/j.ajo.2017.06.018
      Issue No: Vol. 181 (2017)
       
  • Risk Factors for Secondary Glaucoma in Herpetic Anterior Uveitis
    • Authors: Lisette Hoeksema; Nomdo M. Jansonius; Leonoor I. Los
      Pages: 55 - 60
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): Lisette Hoeksema, Nomdo M. Jansonius, Leonoor I. Los
      Purpose To determine the incidence of elevated intraocular pressure (IOP) and secondary glaucoma in herpetic anterior uveitis (AU), owing to either herpes simplex or varicella zoster virus, by using the Standardization of Uveitis Nomenclature (SUN) criteria, and to identify risk factors for the development of glaucoma. Design Retrospective observational cohort study. Methods Patients with herpetic AU presenting themselves between 2001 and 2013 at the ophthalmology department of the University Medical Center Groningen were included. Main outcome measures were the incidence of elevated IOP and glaucoma and risk factors for the development of glaucoma. Results Seventy-three herpetic AU patients were included. Ocular complications most commonly seen during follow-up for uveitis were elevated IOP (75%), keratitis (59%), dry eyes (34%), posterior synechiae (34%), cataract (32%), and glaucoma (15%). Glaucoma patients, in comparison to non–glaucoma patients, had a higher number of IOP peaks during their follow-up for uveitis (P < .001). The majority of patients with elevated IOP (91%) had this already at the start of the uveitis. Nineteen percent of the patients needed glaucoma surgery. Conclusions Using the SUN criteria, our study confirmed that elevated IOP and secondary glaucoma are major complications in herpetic AU. If an elevated IOP occurred, it was usually already present at the start of a uveitis episode. A risk factor for the development of glaucoma was the number of endured IOP peaks. Future studies are needed to evaluate whether early and prolonged use of antiviral and IOP-lowering medication may prevent glaucoma.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.06.013
      Issue No: Vol. 181 (2017)
       
  • Association of Vascular Versus Avascular Subretinal Hyperreflective
           Material With Aflibercept Response in Age-related Macular Degeneration
    • Authors: Yu Kawashima; Masayuki Hata; Akio Oishi; Sotaro Ooto; Kenji Yamashiro; Hiroshi Tamura; Manabu Miyata; Akihito Uji; Naoko Ueda-Arakawa; Akitaka Tsujikawa
      Pages: 61 - 70
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): Yu Kawashima, Masayuki Hata, Akio Oishi, Sotaro Ooto, Kenji Yamashiro, Hiroshi Tamura, Manabu Miyata, Akihito Uji, Naoko Ueda-Arakawa, Akitaka Tsujikawa
      Purpose To investigate flow signal within subretinal hyperreflective material (SHRM) using optical coherence tomography angiography (OCTA) and its association with aflibercept treatment responses in treatment-naïve neovascular age-related macular degeneration (nAMD). Design Prospective consecutive interventional case series. Methods Forty-four eyes of 44 patients with treatment-naïve nAMD manifesting SHRM on OCT were studied. All patients underwent OCTA and received 3 monthly aflibercept injections. The intrinsic flow signals within SHRM were quantitatively analyzed using OCTA, and eyes were classified into the vascular and avascular SHRM groups. Results Of 44 eyes, 21 (47.7%) and 23 (52.3%) showed vascular SHRM and avascular SHRM, respectively. Compared with eyes with avascular SHRM, eyes with vascular SHRM showed higher rates of external limiting membrane (ELM) disruption owing to SHRM (P = .015), classic choroidal neovascularization (CNV) (85.7% vs 26.1%, P = .87 × 10−4), and intraretinal fluid (P = .008) at baseline. After 3 aflibercept injections, 38 eyes (86.4%) showed dry macula despite persistent SHRM in 24 eyes (54.5%). Compared with the eyes with resolved SHRM, those with persistent SHRM showed higher rate of vascular SHRM (75.0% vs 15.0%, P = .86 × 10−4), classic CNV (P = .032), absence of polypoidal lesion (P = .020), ELM disruption owing to SHRM (P = .042), and intraretinal fluid (P = .008). Dry macula after loading injections was significantly associated with SHRM resolution (P = .025). Conclusions In nAMD, SHRM can be categorized as vascular and avascular by quantitative OCTA analysis. Vascular SHRM persisted after treatment and was associated with failure to achieve dry macula, suggesting that vascular SHRM is predictive of lower response to anti-VEGF therapy.

      PubDate: 2017-07-26T10:31:33Z
      DOI: 10.1016/j.ajo.2017.06.015
      Issue No: Vol. 181 (2017)
       
  • Prevalence of Diabetic Retinopathy and Blindness in Indonesian Adults With
           Type 2 Diabetes
    • Authors: Muhammad Bayu Sasongko; Felicia Widyaputri; Angela Nurini Agni; Firman Setya Wardhana; Satyaprabha Kotha; Prateek Gupta; Tri Wahyu Widayanti; Supanji Haryanto; Rifa Widyaningrum; Tien Yin Wong; Ryo Kawasaki; Jie Jin Wang
      Pages: 79 - 87
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): Muhammad Bayu Sasongko, Felicia Widyaputri, Angela Nurini Agni, Firman Setya Wardhana, Satyaprabha Kotha, Prateek Gupta, Tri Wahyu Widayanti, Supanji Haryanto, Rifa Widyaningrum, Tien Yin Wong, Ryo Kawasaki, Jie Jin Wang
      Purpose To report the prevalence of diabetic retinopathy (DR) and DR-related blindness in an Indonesian population with type 2 diabetes. Methods Design : Population-based cross-sectional study. Setting : Community health centers. Study Population : We recruited 1184 people aged older than 30 years with type 2 diabetes residing in Jogjakarta, Indonesia. Multistage, clustered random sampling based on regencies and districts in Jogjakarta was used. Observation Procedure : Detailed interviews, general and eye examinations, and anthropometric measurement were performed. Disc- and macula-centered retinal photographs were taken to assess DR. The definition of DR followed a modified Airlie House classification system and was categorized into mild, moderate, and vision-threatening DR (VTDR). Main Outcome Measure(s) : Prevalence and severity of DR. Results The median (range) age and diabetes duration of participants was 59 (52–65) and 4 (2–9) years. The prevalence of DR was 43.1% (95% confidence interval 39.6%–46.6%), with mild, moderate, and severe NPDR and PDR to be 9.41%, 7.46%, 11.1%, and 12.1%, respectively. The prevalence of VTDR was 26.3% (23.1%–29.5%). Longer diabetes duration, higher fasting glucose, presence of hypertension, and foot ulcers were associated with DR and VTDR. The prevalence of bilateral blindness was 4% and 7.7% in persons with DR and VTDR. Conclusions This study reports a high prevalence of any DR and VTDR among Indonesian adults with type 2 diabetes in urban and rural areas: approximately 1 in 4 adults with diabetes had VTDR and 1 in 12 of those with VTDR was bilaterally blind, suggesting the need for appropriate screening and management of DR among the Indonesian population.

      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.06.019
      Issue No: Vol. 181 (2017)
       
  • Combined Hamartoma of the Retina and Retinal Pigment Epithelium: An
           Optical Coherence Tomography–Based Reappraisal
    • Authors: Rohan Chawla; Vinod Kumar; Koushik Tripathy; Atul Kumar; Pradeep Venkatesh; Farin Shaikh; Rajpal Vohra; Kabiruddin Molla; Saurabh Verma
      Pages: 88 - 96
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): Rohan Chawla, Vinod Kumar, Koushik Tripathy, Atul Kumar, Pradeep Venkatesh, Farin Shaikh, Rajpal Vohra, Kabiruddin Molla, Saurabh Verma
      Purpose To analyze the optical coherence tomography (OCT) characteristics of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) involving the macula. Design Retrospective, observational case series. Methods setting : Single institutional. study population : Fourteen consecutive patients of CHRRPE were included. observation procedures : The authors analyzed the clinical features, color fundus photography, and swept-source or spectral-domain OCT of all the involved eyes. main outcome measures : OCT characteristics, especially the involvement of the retinal pigment epithelium (RPE). Results A total of 16 eyes of 5 female and 9 male patients were analyzed. The mean age (± SD) was 17.9 ± 6.4 (range 10–34) years. Mean best-corrected visual acuity (± SD) in logMAR was 0.9 ± 0.5 (20/160 ± 20/60). The OCT was suggestive of a focal mass-like lesion primarily involving the inner retinal layers limited externally by the outer plexiform layer (OPL) in 15 eyes (93.7%). The OPL appeared to have a saw-tooth appearance (“intraretinal peaks”) in 12 eyes (75%). The convolutions of the OPL were broader and deeper in some eyes (5 eyes, 31.2%), giving an “omega sign” (ω) appearance. The ellipsoid zone appeared intact in 13 eyes (81.2%). The RPE band appeared intact in all eyes. Conclusions Considering the OCT features, available evidence, and embryology, we propose that the true nature of CHRRPE should be reanalyzed. In our series, CHRRPE was noted to be primarily a hamartoma arising from the inner retinal layers. A majority of cases were limited posteriorly by the OPL without any involvement of the outer retinal layers and RPE.

      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.06.020
      Issue No: Vol. 181 (2017)
       
  • Late Solitary Extraocular Recurrence From Previously Resected Iris
           Melanoma
    • Authors: Ido Didi Fabian; Caroline Thaung; Lamis AlHarby; Karen Sisley; Hardeep S. Mudhar; Rachel E. Doherty; Andrew W. Stacey; Amit K. Arora; Victoria M.L. Cohen; Mandeep S. Sagoo
      Pages: 97 - 105
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): Ido Didi Fabian, Caroline Thaung, Lamis AlHarby, Karen Sisley, Hardeep S. Mudhar, Rachel E. Doherty, Andrew W. Stacey, Amit K. Arora, Victoria M.L. Cohen, Mandeep S. Sagoo
      Purpose To report on cases of late extraocular relapse of previously resected iris melanoma, without concurrent intraocular recurrence. Design Retrospective case series. Methods A retrospective chart review of 4 patients diagnosed with late subconjunctival relapse of previously resected iris melanoma. Results Three female patients and 1 male patient underwent iris tumor resection and presented to our service with suspicious conjunctival lesions at a median of 22 years later (mean: 21 years). None showed intraocular relapse. Treatment of the conjunctival tumors included excisional biopsy (n = 4), followed by cryotherapy (n = 3) and/or brachytherapy (n = 3). In all cases, histopathology confirmed malignant melanoma, with no intraepithelial component or associated melanosis. Genetic sequencing (n = 3) showed wild-type BRAF and NRAS in all. GNA11 mutation was found in 1 case. On array-based comparative genomic hybridization (n = 3), gain of 6p was found in 2 cases and gain of 8 in 2. Overall, findings were strongly suggestive of a diagnosis of late extraocular relapse from previously resected iris melanoma. In a median of 2.5 years (mean: 7.7 years) from the subconjunctival relapse, no further episodes of intraocular/extraocular recurrence were recorded, and all patients were free from distant metastasis. Conclusions Patients undergoing iris melanoma resection are at risk of developing late solitary extraocular relapse even more than 30 years after surgery. In the absence of an intraocular component, diagnosis may be challenging, as tumors mimic a primary conjunctival lesion. Management by excisional biopsy followed by adjuvant therapy was successful, and histopathology and genetic analysis supported a diagnosis of extraocular uveal tumor spread rather than a primary conjunctival tumor.

      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.06.025
      Issue No: Vol. 181 (2017)
       
  • Impact of Normal Aging and Progression Definitions on the Specificity of
           Detecting Retinal Nerve Fiber Layer Thinning
    • Authors: Zhichao Wu; Luke J. Saunders; Linda M. Zangwill; Fábio B. Daga; Jonathan G. Crowston; Felipe A. Medeiros
      Pages: 106 - 113
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): Zhichao Wu, Luke J. Saunders, Linda M. Zangwill, Fábio B. Daga, Jonathan G. Crowston, Felipe A. Medeiros
      Purpose To evaluate the specificity of current definitions used to identify progressive change of the average peripapillary retinal nerve fiber layer (RNFL) thickness measurements obtained on optical coherence tomography (OCT) imaging. Design Prospective observational cohort study. Methods Setting : University of California, San Diego. Study Population : Seventy-five eyes from 45 normal participants. Observation Procedure : Patients were seen at an average of 5.7 visits over 3.2 years, to determine the age-related average RNFL thickness changes and longitudinal measurement variability. Slope and variability estimates were used to reconstruct “real-world” OCT imaging measurements with computer simulations. Main Outcome Measure : False-positive rates for progression in normal eyes using different definitions. Results The estimated normal average RNFL thickness change over time was −0.54 ± 0.23 μm/year (P < .001). Even with a recent definition of progression that appeared to guarantee a high level of specificity by accounting for normal aging (requiring a significant negative slope that was more negative than the 5% lower limit of aging), 18% simulated normal eyes were still falsely identified as having progressed after 5 years of annual testing in a clinical practice scenario. However, this was reduced to 8% and 4% when trend-based analysis of progression was performed after adjustments using the mean and 5% lower limit of normal rates of aging, respectively. Conclusions This study highlights how current definitions for detecting RNFL thinning have an unacceptably poor level of specificity, and that more stringent definitions are required to avoid misleading interpretations of progression on OCT imaging in clinical practice.

      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.06.017
      Issue No: Vol. 181 (2017)
       
  • Impaired Autoregulation of Blood Flow at the Optic Nerve Head During
           Vitrectomy in Patients With Type 2 Diabetes
    • Authors: Ryuya Hashimoto; Tetsuya Sugiyama; Hidetaka Masahara; Masashi Sakamoto; Makoto Ubuka; Takatoshi Maeno
      Pages: 125 - 133
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): Ryuya Hashimoto, Tetsuya Sugiyama, Hidetaka Masahara, Masashi Sakamoto, Makoto Ubuka, Takatoshi Maeno
      Purpose To determine whether type 2 diabetes mellitus (T2DM) influences autoregulation of optic nerve head (ONH) blood flow during vitrectomy. Design Cohort study. Methods Thirteen eyes of 13 subjects with T2DM and 30 eyes of 30 controls without T2DM undergoing vitrectomy for epiretinal membrane or macular hole were included. Following 25 gauge vitrectomy, we measured the mean blur rate (MBR), an index of ONH blood flow, in the vascular area (vascular MBR) and in the tissue area (tissue MBR) using laser speckle flowgraphy. We performed measurements before and 5 and 10 minutes after intraocular pressure (IOP) elevation of approximately 15 mm Hg; both parameters represent relative values (%, compared with baseline). We calculated the vascular MBR recovery rate as (vascular MBR at 10 min–vascular MBR at 5 min)/(vascular MBR at baseline–vascular MBR at 5 min). Results Vascular MBR in T2DM subjects was significantly lower than that in controls at 5 and 10 minutes after IOP elevation (P = .0328 and P < .0001, respectively). Tissue MBR was also significantly lower in T2DM subjects than in controls at both time points (P = .0253 and P = .0004, respectively). Vascular MBR recovery rate was significantly lower in the T2DM than in the control group (P = .0090). Furthermore, the vascular MBR recovery rate was significantly negatively correlated with hemoglobin A1c and fasting plasma glucose levels (P = .0284 and P = .0381, respectively). Conclusions T2DM is associated with impaired ONH blood flow autoregulation in both vascular and tissue areas when subjected to change in IOP during vitrectomy.

      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.06.021
      Issue No: Vol. 181 (2017)
       
  • The American Journal of Ophthalmology, Not an “American”
           Journal of Ophthalmology
    • Authors: Richard K. Parrish; Sarah L. Duncan Powers
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Richard K. Parrish, Sarah L. Duncan Powers


      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.06.001
      Issue No: Vol. 180 (2017)
       
  • Rituximab for the Treatment of Autoimmune Retinopathy
    • Authors: Farzin Forooghian; Ian M. MacDonald
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Farzin Forooghian, Ian M. MacDonald


      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.06.006
      Issue No: Vol. 180 (2017)
       
  • Anisometropia at Age 5 Years After Unilateral Intraocular Lens
           Implantation During Infancy in the Infant Aphakia Treatment Study
    • Authors: David Weakley; George Cotsonis; M. Edward Wilson; David A. Plager; Edward G. Buckley; Scott R. Lambert
      Pages: 1 - 7
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): David Weakley, George Cotsonis, M. Edward Wilson, David A. Plager, Edward G. Buckley, Scott R. Lambert
      Purpose To report the prevalence of anisometropia at age 5 years after unilateral intraocular lens (IOL) implantation in infants. Design Prospective randomized clinical trial. Methods Fifty-seven infants in the Infant Aphakia Treatment Study (IATS) with a unilateral cataract were randomized to IOL implantation with an initial targeted postoperative refractive error of either +8 diopters (D) (infants 28 to <48 days of age) or +6 D (infants 48–210 days of age). Anisometropia was calculated at age 5 years. Six patients were excluded from the analyses. Results Median age at cataract surgery was 2.2 months (interquartile range [IQR], 1.2, 3.5 months). The mean age at the age 5 years follow-up visit was 5.0 ± 0.1 years (range, 4.9–5.4 years). The median refractive error at the age 5 years visit of the treated eyes was −2.25 D (IQR −5.13, +0.88 D) and of the fellow eyes +1.50 D (IQR +0.88, +2.25). Median anisometropia was −3.50 D (IQR −8.25, −0.88 D); range −19.63 to +2.75 D. Patients with glaucoma in the treated eye (n = 9) had greater anisometropia (glaucoma, median −8.25 D; IQR −11.38, −5.25 D vs no glaucoma median −2.75; IQR −6.38, −0.75 D; P = .005). Conclusions The majority of pseudophakic eyes had significant anisometropia at age 5 years. Anisometropia was greater in patients that developed glaucoma. Variability in eye growth and myopic shift continue to make refractive outcomes challenging for IOL implantation during infancy.

      PubDate: 2017-06-12T09:26:32Z
      DOI: 10.1016/j.ajo.2017.05.008
      Issue No: Vol. 180 (2017)
       
  • Relationship Between Visual Acuity and Retinal Thickness During
           Anti–Vascular Endothelial Growth Factor Therapy for Retinal Diseases
    • Authors: William C. Ou; David M. Brown; John F. Payne; Charles C. Wykoff
      Pages: 8 - 17
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): William C. Ou, David M. Brown, John F. Payne, Charles C. Wykoff
      Purpose To investigate the relationship between best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in eyes receiving ranibizumab for 3 common retinal diseases. Design Retrospective analysis of clinical trial data. Methods Early Treatment Diabetic Retinopathy Study BCVA and spectral-domain optical coherence tomography–measured CRT of 387 eyes of 345 patients enrolled in 6 prospective clinical trials for management of neovascular age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vein occlusion (RVO) were evaluated by Pearson correlation and linear regression. Results At baseline, there was a small correlation between BCVA and CRT in pooled AMD trial data (r = −0.24). A medium correlation was identified in pooled DME trial data (r = −0.42). No correlation was found in pooled RVO trial data. At month 12, no correlation was found between changes from baseline in BCVA and CRT in pooled AMD trial data. Medium correlations were identified in both pooled DME (r = −0.45) and pooled RVO (r = −0.35) trial data at month 12. Changes in BCVA and CRT associated with edema recurrence upon transition from monthly to pro re nata (PRN) dosing were correlated in AMD (r = −0.27) and RVO (r = −0.72) trials, but not in DME trial data. Conclusion DME demonstrated a convincing relationship between BCVA and CRT. Correlations appear to be more complex in AMD and RVO. At the inflection point between monthly and PRN dosing, when recurrence of edema is anticipated in many patients, CRT appears strongly correlated with loss of BCVA in RVO.

      PubDate: 2017-06-12T09:26:32Z
      DOI: 10.1016/j.ajo.2017.05.014
      Issue No: Vol. 180 (2017)
       
  • Optimizing Glaucoma Screening in High-Risk Population: Design and 1-Year
           Findings of the Screening to Prevent (SToP) Glaucoma Study
    • Authors: Di Zhao; Eliseo Guallar; Prateek Gajwani; Bonnielin Swenor; John Crews; Jinan Saaddine; Lucy Mudie; Varshini Varadaraj; David S. Friedman; Natasha Kanwar; Allan Sosa-Ebert; Niccolo Dosto; Sean Thompson; Madison Wahl; Egwuonwu Johnson; Clinton Ogega
      Pages: 18 - 28
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Di Zhao, Eliseo Guallar, Prateek Gajwani, Bonnielin Swenor, John Crews, Jinan Saaddine, Lucy Mudie, Varshini Varadaraj, David S. Friedman
      Purpose To develop, implement, and evaluate a replicable community-based screening intervention designed to improve glaucoma and other eye disease detection and follow-up care in high-risk populations in the United States. We present the design of the study and describe the findings of the first year of the program. Design Prospective study to evaluate screening and follow-up. Methods This is an ongoing study to develop an eye screening program using trained personnel to identify individuals with ophthalmic needs, focusing on African Americans ≥50 years of age at multiple inner-city community sites in Baltimore, Maryland. The screening examination uses a sequential referral approach and assesses presenting visual acuity (VA), best-corrected VA, digital fundus imaging, visual field testing, and measurement of intraocular pressure. Results We screened 901 individuals between January 2015 and October 2015. Subjects were mostly African Americans (94.9%) with a mean (standard deviation) age of 64.3 (9.9) years. Among them, 356 (39.5%) participants were referred for a definitive eye examination and 107 (11.9%) only needed prescription glasses. The most common reasons for referral were ungradable fundus image (39.3% of those referred), best-corrected VA < 20/40 (14.6%), and ungradable autorefraction (11.8%). Among people referred for definitive examination, 153 (43%) people attended their scheduled examination. The most common diagnoses at the definitive examination were glaucoma and cataract (51% and 40%, respectively). Conclusions A large proportion of individuals screened required ophthalmic services, particularly those who were older and less well educated. To reach and encourage these individuals to attend screenings and follow-up examinations, programs could develop innovative strategies and approaches.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.05.017
      Issue No: Vol. 180 (2017)
       
  • Physical Activity and Age-related Macular Degeneration: A Systematic
           Literature Review and Meta-analysis
    • Authors: Myra B. McGuinness; Jerome Le; Paul Mitchell; Bamini Gopinath; Ester Cerin; Nicole T.M. Saksens; Tina Schick; Carel B. Hoyng; Robyn H. Guymer; Robert P. Finger
      Pages: 29 - 38
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Myra B. McGuinness, Jerome Le, Paul Mitchell, Bamini Gopinath, Ester Cerin, Nicole T.M. Saksens, Tina Schick, Carel B. Hoyng, Robyn H. Guymer, Robert P. Finger
      Purpose To better understand the association, in a white population, of physical activity and age-related macular degeneration (AMD)—the main cause of irreversible severe vision loss in developed countries—given the suggestion that a healthy lifestyle may assist in delaying the onset and progression of AMD. Design Systematic review and meta-analysis. Methods Medline, EMBASE, and Google Scholar were systematically searched for studies up to May 2015. Reference lists of published articles were hand searched and study authors were contacted to provide additional data. Those in the lowest category of activity in each study were compared with all other participants to assess the association between physical activity and both early and late AMD using random-effects meta-analysis. Results Nine studies (subject age range 30–97 years) were included in the meta-analysis. Physical activity was found to have a protective association with both early AMD (8 studies, n = 38 112, odds ratio (OR) 0.92, 95% confidence interval [CI] 0.86–0.98) and late AMD (7 studies, n = 28 854, OR 0.59, 95% CI 0.49–0.72). Conclusions Physical activity is associated with lower odds of early and late AMD in white populations. These findings have important implications, reinforcing the public health message of staying active throughout life. However, further longitudinal studies are required to confirm and further characterize a protective effect of physical activity on the onset and/or progression of AMD.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.05.016
      Issue No: Vol. 180 (2017)
       
  • Pattern of Local Recurrence After I-125 Episcleral Brachytherapy for Uveal
           Melanoma in a Spanish Referral Ocular Oncology Unit
    • Authors: Sara Sánchez-Tabernero; Ciro García-Alvarez; Ma Fe Muñoz-Moreno; Patricia Diezhandino; Pilar Alonso-Martínez; Jesus M. de Frutos-Baraja; Francisco López-Lara; Maria A. Saornil
      Pages: 39 - 45
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Sara Sánchez-Tabernero, Ciro García-Alvarez, M Fe Muñoz-Moreno, Patricia Diezhandino, Pilar Alonso-Martínez, Jesus M. de Frutos-Baraja, Francisco López-Lara, Maria A. Saornil
      Purpose To describe the time, frequency, and clinical characteristics of treatment failure after I-125 brachytherapy in patients with uveal melanoma treated and followed in a Spanish referral ocular oncology unit. Design Prospective, consecutive, interventional case series. Methods Patients diagnosed with uveal melanoma from 1995 to 2016 and treated with episcleral brachytherapy were included. Demographic data collection, ophthalmic evaluation, ultrasound scan, and systemic studies were performed at baseline, every 6 months thereafter for 5 years, and subsequently at annual intervals. Recurrence was defined as presence of tumor growth after treatment. Baseline analysis was performed by descriptive methods and survival by Kaplan-Meier curves. Results From 732 patients diagnosed with uveal melanoma, 311 were treated with brachytherapy. In the follow-up (mean 79 months, standard deviation = 55), 16 local tumor recurrences (5.1%) were detected. All relapsing patients had choroidal tumors and 15 presented with visual symptoms. All patients were treated with I-125 brachytherapy, and 2 received associated transpupillary thermotherapy. All the eyes were enucleated after recurrence. Kaplan-Meier analysis showed a mean time of recurrence of 3.7 years (standard deviation = 2.94 years, ranging from 1 to 12 years). Three patients had metastasis in the follow-up. Kaplan-Meier analysis showed worse survival for patients with recurrence. Conclusion Local treatment failure was a relatively infrequent event after I-125 brachytherapy in our series. Recurrences appear not only early but also late in the follow-up. They do not have a distinctive clinical pattern and are associated with poorer survival.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.05.019
      Issue No: Vol. 180 (2017)
       
  • Orbital and Orbitocranial Trauma From Pencil Fragments: Role of Timely
           Diagnosis and Management
    • Authors: Won-Kyung Cho; Audrey C. Ko; Habibullah Eatamadi; Abdelqadir Al-Ali; Jean-Paul Abboud; Don O. Kikkawa; Bobby S. Korn
      Pages: 46 - 54
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Won-Kyung Cho, Audrey C. Ko, Habibullah Eatamadi, Abdelqadir Al-Ali, Jean-Paul Abboud, Don O. Kikkawa, Bobby S. Korn
      Purpose To emphasize the importance of early detection and radiologic evaluation of retained organic foreign bodies (FBs) in orbital or orbitocranial penetrating injuries by pencil. Design Retrospective case series. Methods A retrospective chart review of patients who had penetrating orbital or orbitocranial trauma at 2 tertiary hospitals was conducted. Patients whose mechanism of injury was penetrating trauma by pencil were included. The patients' demographics, time between initial trauma and detection of foreign body, radiologic images, and resulting sequelae were reviewed. Results Four patients were included in this study. All patients were male; 3 were less than 2 years of age and 1 was 34 years old. Accidents were witnessed in 2 cases, and initial detections of FBs were delayed in 3 cases, from 2 days to 7 weeks. Three cases involved the right orbit. Computed tomography (CT) imaging of the head demonstrated penetration of the orbital walls in 3 cases. Three-dimensional CT scans were used to differentiate the penetrating graphite pencil fragments from the orbital wall, and catheter angiography was used in 1 case of suspected orbital apex penetration. Vision was lost in 1 patient while other severe neurologic deficits were fully recovered after removal of FB. Conclusions Penetrating injury by pencils to the periorbital structures and delayed detection of retained pencil fragments can result in threat to life and vision. Radiologic examinations are essential to the detection of these retained FBs. Prompt detection and removal of the FBs within 48 hours and treatment with antibiotics can save vision and life.

      PubDate: 2017-06-16T09:30:19Z
      DOI: 10.1016/j.ajo.2017.05.018
      Issue No: Vol. 180 (2017)
       
  • Choroidal Changes Associated With Subretinal Drusenoid Deposits in
           Age-related Macular Degeneration Using Swept-source Optical Coherence
           Tomography
    • Authors: Inês Laíns; Jay Wang; Joana Providência; Steven Mach; Pedro Gil; João Gil; Marco Marques; Grayson Armstrong; Shady Garas; Patrícia Barreto; Ivana K. Kim; Demetrios G. Vavvas; Joan W. Miller; Deeba Husain; Rufino Silva; John B. Miller
      Pages: 55 - 63
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Inês Laíns, Jay Wang, Joana Providência, Steven Mach, Pedro Gil, João Gil, Marco Marques, Grayson Armstrong, Shady Garas, Patrícia Barreto, Ivana K. Kim, Demetrios G. Vavvas, Joan W. Miller, Deeba Husain, Rufino Silva, John B. Miller
      Purpose To compare choroidal vascular features of eyes with and without subretinal drusenoid deposits (SDD), using swept-source optical coherence tomography (SS OCT). Design Multicenter, cross-sectional study. Methods We prospectively recruited patients with intermediate age-related macular degeneration (AMD), without other vitreoretinal pathology. All participants underwent complete ophthalmic examination, color fundus photography (used for AMD staging), and spectral-domain OCT (to evaluate the presence of SDD). SS OCT was used to obtain automatic macular choroidal thickness (CT) maps, according to the Early Treatment Diabetic Retinopathy Study (ETDRS) sectors. For data analysis, we considered mean choroidal thickness as the arithmetic mean value of the 9 ETDRS sectors. SS OCT en face images of choroidal vasculature were also captured and converted to binary images. Choroidal vascular density (CVD) was calculated as a percent area occupied by choroidal vessels in a 6-mm-diameter submacular circular. Choroidal vessel volume was calculated by multiplying the average CVD by macular area and CT. Multilevel mixed linear models (to account for the inclusion of 2 eyes of same subject) were performed for analysis. Results We included 186 eyes (n = 118 subjects), 94 (50.5%) presenting SDD. Multiple regression analysis revealed that, controlling for age, eyes with SDD presented a statistically thinner mean CT (ß = −21.9, P = .006) and CT in all the individual ETDRS fields (ß ≤ −18.79, P ≤ .026). Mean choroidal vessel volume was also significantly reduced in eyes with SDD (ß = −0.003, P = .007). No significant associations were observed with mean CVD. Conclusion In subjects with intermediate AMD, choroidal thickness and vessel volume are reduced in the presence of subretinal drusenoid deposits.

      PubDate: 2017-06-22T09:38:55Z
      DOI: 10.1016/j.ajo.2017.05.021
      Issue No: Vol. 180 (2017)
       
  • The United Kingdom Diabetic Retinopathy Electronic Medical Record Users
           Group: Report 3: Baseline Retinopathy and Clinical Features Predict
           Progression of Diabetic Retinopathy
    • Authors: Cecilia S. Lee; Aaron Y. Lee; Douglas Baughman; Dawn Sim; Toks Akelere; Christopher Brand; David P. Crabb; Alastair K. Denniston; Louise Downey; Alan Fitt; Rehna Khan; Sajad Mahmood; Kaveri Mandal; Martin Mckibbin; Geeta Menon; Aires Lobo; B. Vineeth Kumar; Salim Natha; Atul Varma; Elizabeth Wilkinson; Danny Mitry; Clare Bailey; Usha Chakravarthy; Adnan Tufail; Catherine Egan; Usha Chakravarthy; Faruque Ghanchi; Rehna Khan; Jong Min Ong; Sajjad Mahmood; Geeta Menon; Quresh Mohamed; Saher Al-Husainy; Toks Akelere; Louise Downey; Marin Mckibbin; Narendra Dhingra; Elizabeth Wilkinson; Sumit Dhingra; Richard Antcliff; Alastair K. Denniston; Clare Bailey; Kaveri Mandal; Vineeth Kumar; Salim Natha
      Pages: 64 - 71
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Cecilia S. Lee, Aaron Y. Lee, Douglas Baughman, Dawn Sim, Toks Akelere, Christopher Brand, David P. Crabb, Alastair K. Denniston, Louise Downey, Alan Fitt, Rehna Khan, Sajad Mahmood, Kaveri Mandal, Martin Mckibbin, Geeta Menon, Aires Lobo, B. Vineeth Kumar, Salim Natha, Atul Varma, Elizabeth Wilkinson, Danny Mitry, Clare Bailey, Usha Chakravarthy, Adnan Tufail, Catherine Egan
      Purpose To determine the time and risk factors for developing proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH). Design Multicenter, national cohort study. Methods Anonymized data of 50 254 patient eyes with diabetes mellitus at 19 UK hospital eye services were extracted at the initial and follow-up visits between 2007 and 2014. Time to progression of PDR and VH were calculated with Cox regression after stratifying by baseline diabetic retinopathy (DR) severity and adjusting for age, sex, race, and starting visual acuity. Results Progression to PDR in 5 years differed by baseline DR: no DR (2.2%), mild (13.0%), moderate (27.2%), severe nonproliferative diabetic retinopathy (NPDR) (45.5%). Similarly, 5-year progression to VH varied by baseline DR: no DR (1.1%), mild (2.9%), moderate (7.3%), severe NPDR (9.8%). Compared with no DR, the patient eyes that presented with mild, moderate, and severe NPDR were 6.71, 14.80, and 28.19 times more likely to develop PDR, respectively. In comparison to no DR, the eyes with mild, moderate, and severe NPDR were 2.56, 5.60, and 7.29 times more likely to develop VH, respectively. In severe NPDR, the eyes with intraretinal microvascular abnormalities (IRMA) had a significantly increased hazard ratio (HR) of developing PDR (HR 1.77, 95% confidence interval [CI] 1.25–2.49, P = .0013) compared with those with venous beading, whereas those with 4-quadrant dot-blot hemorrhages (4Q DBH) had 3.84 higher HR of developing VH (95% CI 1.39–10.62, P = .0095). Conclusions Baseline severities and features of initial DR are prognostic for PDR development. IRMA increases risk of PDR whereas 4Q DBH increases risk of VH.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.05.020
      Issue No: Vol. 180 (2017)
       
  • Classification of Fluorescein Breakup Patterns: A Novel Method of
           Differential Diagnosis for Dry Eye
    • Authors: Norihiko Yokoi; Georgi As. Georgiev; Hiroaki Kato; Aoi Komuro; Yukiko Sonomura; Chie Sotozono; Kazuo Tsubota; Shigeru Kinoshita
      Pages: 72 - 85
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Norihiko Yokoi, Georgi As. Georgiev, Hiroaki Kato, Aoi Komuro, Yukiko Sonomura, Chie Sotozono, Kazuo Tsubota, Shigeru Kinoshita
      Purpose To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases. Design Cross-sectional study. Methods In 106 eyes of 106 subjects (19 male, 87 female; mean age: 64.2 years), FBUPs were categorized into 1 of the following 5 break (B) types: area (AB, n = 19); spot (SB, n = 22); line (LB, n = 24); dimple (DB, n = 19); random (RB, n = 22 eyes); and dry eye–related symptoms using the visual analog scale (VAS, 100 mm = maximum), tear meniscus radius (TMR, mm), tear film lipid layer interference grade (IG) (grades 1–5; 1 = best) and spread grade (SG) (grades 1–4; 1 = best), tear film noninvasive breakup time (NIBUT, seconds), fluorescein breakup time (FBUT, seconds), corneal-epithelial damage (CED) score (15 points = maximum), ocular surface epithelial damage (OSED) score (9 points = maximum), and the Schirmer 1 test (ST1, mm) were examined and compared between each FBUP. Results In each FBUP, eye dryness and fatigue were the severest symptoms. Characteristic symptoms were sensitivity to light, heavy eyelids, pain, foreign body sensation, difficulty opening the eye, and discharge for AB, heavy eyelids for SB, and foreign-body sensation for LB. Statistically significant differences were found in TMR (AB-SB, -DB, and -RB; LB-RB), IG (AB-all other FBUP; LB-SB and -DB), and SG (AB-all other FBUPs), FBUT (AB-LB, -DB, and -RB; SB-DB and -RB; LB-RB; DB-RB), and NIBUT (AB-all other FBUPs; SB-DB and-RB, and LB-RB), CED (AB-all other FBUPs; LB-SB, -DB, and -RB) and OSED (AB-SB, -LB, and -DB; LB-SB, -DB, and -RB), and ST1 (AB-SB, -DB, and -LB) (P < .05 in each comparison). Conclusions The 5 different FBUPs constituted different groups, reflecting different pathophysi-ologies.

      PubDate: 2017-06-22T09:38:55Z
      DOI: 10.1016/j.ajo.2017.05.022
      Issue No: Vol. 180 (2017)
       
  • Practice Patterns Among Eye Care Providers at US Teaching Hospitals With
           Regard to Assessing and Educating Patients About Smoking
    • Authors: Zachary C. Landis; Ramunas Rolius; Ingrid U. Scott
      Pages: 86 - 90
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Zachary C. Landis, Ramunas Rolius, Ingrid U. Scott
      Purpose To investigate practice patterns of eye care providers at academic medical centers in the United States (US) with regard to assessing patients' smoking status and exposure, educating patients regarding ocular risks of smoking, and counseling patients about smoking cessation. Design Cross-sectional survey. Methods An anonymous survey including multiple choice and Likert-style questions was constructed on http://www.surveymonkey.com and emailed to the coordinators of all 113 US ophthalmology residency programs, with a request to forward to all faculty, fellows, residents, and optometrists at their institution. Main outcome measures include proportion of eye care providers who assess patients' smoking status, educate patients regarding ocular risks of smoking, and discuss with patients smoking cessation options. Results Of the 292 respondents, 229 (78%) “always” or “periodically” ask patients about their smoking status, 251 (86%) “seldom” or “never” ask patients about secondhand smoke exposure, 245 (84%) “always” or “periodically” educate patients about ocular diseases associated with smoking, 142 (49%) “seldom” or “never” ask patients who smoke about their willingness to quit smoking, and 249 (85%) “seldom” or “never” discuss potential methods and resources to assist with smoking cessation. Conclusions Most eye care providers assess patients' smoking status and educate patients regarding ocular risks of smoking. However, approximately half do not ask, or seldom ask, about patients' willingness to quit smoking, and most do not discuss smoking cessation options.

      PubDate: 2017-06-22T09:38:55Z
      DOI: 10.1016/j.ajo.2017.05.023
      Issue No: Vol. 180 (2017)
       
  • Socioeconomic Disparity in Global Burden of Cataract: An Analysis for 2013
           With Time Trends Since 1990
    • Authors: Lixia Lou; Jingyi Wang; Peifang Xu; Xin Ye; Juan Ye
      Pages: 91 - 96
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Lixia Lou, Jingyi Wang, Peifang Xu, Xin Ye, Juan Ye
      Purpose To assess socioeconomic disparity in global burden of cataract, by using disability-adjusted life years (DALYs). Design International, comparative burden-of-disease study. Methods Published data on national age-standardized DALY rates caused by cataract and human development index (HDI) between 1990 and 2013 were obtained. The association between age-standardized DALY rates and HDI in 2013 was analyzed. The health-related Gini coefficients and the concentration indexes were calculated to explore the trends in between-country inequality in cataract burden from 1990 to 2013. Results Multiple comparison revealed that lower-HDI countries had higher age-standardized DALY rates caused by cataract. Age-standardized DALY rates were inversely associated with HDI (β = −0.522, P < .01). From 1990 to 2013, global age-standardized DALY rates showed a trend of decline, whereas the Gini coefficients increased from 0.409 to 0.439. The concentration indexes indicated that socioeconomic-associated inequality declined in the 1990s and subsequently increased since 2000, with values of −0.259 in 1990, −0.244 in 2000, and −0.273 in 2013. Conclusions Global health progress in cataract was accompanied by widening inequality, with cataract burden being more concentrated in countries with lower socioeconomic status. The findings highlight the need to provide more cataract services for developing countries, to combat global vision loss caused by cataract.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.04.008
      Issue No: Vol. 180 (2017)
       
  • Retinal Detachment Associated With Basketball-Related Eye Trauma
    • Authors: Tsung-Han Lee; Yi-Hao Chen; Hsi-Kung Kuo; Yung-Jen Chen; Chih-Hsin Chen; Jong-Jer Lee; Pei-Chang Wu
      Pages: 97 - 101
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Tsung-Han Lee, Yi-Hao Chen, Hsi-Kung Kuo, Yung-Jen Chen, Chih-Hsin Chen, Jong-Jer Lee, Pei-Chang Wu
      Purpose Basketball is a popular sport involving significant body contact, which may frequently result in ocular trauma. The aim of this study was to evaluate the characteristics and visual outcomes of retinal detachment associated with basketball-related injury. Design Retrospective, interventional case series. Methods We reviewed the course of patients who sustained traumatic retinal detachment from basketball-related ocular trauma between 2003 and 2015. Results Thirteen patients were evaluated for basketball-related traumatic retinal detachment. Twelve (92%) were male and 1 (8%) female, with an average age of 18.2 years. The majority (9 of 13, 70%) of patients had moderate-to-high myopia, and none were using protective eyewear when they sustained the eye trauma. Rhegmatogenous retinal detachment was observed in all eyes. The preoperative mean visual acuity was 20/625 (range, hand motions to 20/20). Initial surgery using scleral buckling alone was performed in most (8 of 13, 62%) of the patients. Retinal reattachment was achieved in 10 (76%) eyes after the first operation and in 12 (92%) at the end of the intervention. The mean follow-up was 3.9 years (range, 4 months to 12 years). The visual acuity during last follow-up was 20/231 (range, light perception to 20/20). In the multivariable analysis, initial visual acuity was an independent factor affecting the final visual outcome (P = .006). Conclusion Retinal detachment associated with basketball-related injury may cause severe visual loss. In the current study, all retinal detachments were of rhegmatogenous type and commonly occurred in young individuals with myopia. Initial visual acuity was associated with the prognosis. Risk awareness for early detection and intervention are important in these traumas.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.05.025
      Issue No: Vol. 180 (2017)
       
  • Tomographic Analysis of Anterior and Posterior and Total Corneal
           Refractive Power Changes After Femtosecond Laser–Assisted Keratotomy
    • Authors: Franziska Löffler; Myriam Böhm; Michael Herzog; Kerstin Petermann; Thomas Kohnen
      Pages: 102 - 109
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Franziska Löffler, Myriam Böhm, Michael Herzog, Kerstin Petermann, Thomas Kohnen
      Purpose To analyze the effect of penetrating femtosecond laser–assisted keratotomy (pFLAK) during laser lens surgery on anterior and posterior corneal astigmatism and total corneal refractive power (TCRP) astigmatism (CAant, CApost, CATCRP) measured with Scheimpflug tomography. Design Prospective, interventional case series. Methods This institutional study included 27 eyes of 23 patients (aged 65 ± 8 years) with low-to-moderate CATCRP determined with Scheimpflug tomography (Pentacam HR; Oculus, Wetzlar, Germany) after penetrating femtosecond laser–assisted keratotomy (pFLAK) and laser lens surgery. The CAant, CApost, and CATCRP were determined before and 1 and 3 months after surgery. Vector analysis according to the Alpins method was used to calculate surgically induced astigmatism (SIA). Results The mean preoperative CAant (0.97 ± 0.30 diopter [D]) was significantly reduced to 0.63 ± 0.34 D (P < .001). SIAant was 0.71 ± 0.37 D. The CApost showed no significant change, from preoperative 0.26 ± 0.12 D to 0.26 ± 0.10 D postoperatively (P = .625). In line with this finding, SIApost was low (0.12 ± 0.07 D). The CATCRP showed similar results as CAant. Conclusion pFLAKs planned according to Scheimpflug-based CATCRP result in a significant reduction of the CAant and CATCRP, but do not affect the posterior corneal curvature significantly, as measured by Scheimpflug tomography. Further research is required to develop a new valid nomogram for laser-assisted lens surgery.

      PubDate: 2017-07-01T09:49:56Z
      DOI: 10.1016/j.ajo.2017.05.015
      Issue No: Vol. 180 (2017)
       
  • Distribution of Nonperfusion Area on Ultra-widefield Fluorescein
           Angiography in Eyes With Diabetic Macular Edema: DAVE Study
    • Authors: Wenying Fan; Kang Wang; Khalil Ghasemi Falavarjani; Min Sagong; Akihito Uji; Michael Ip; Charles C. Wykoff; David M. Brown; Jano van Hemert; SriniVas R. Sadda
      Pages: 110 - 116
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Wenying Fan, Kang Wang, Khalil Ghasemi Falavarjani, Min Sagong, Akihito Uji, Michael Ip, Charles C. Wykoff, David M. Brown, Jano van Hemert, SriniVas R. Sadda
      Purpose To explore the distribution of nonperfusion area (NPA) in eyes with diabetic macular edema (DME) and its relationship with the severity of DME. Design Prospective, observational case series. Methods Forty eyes of 29 patients with treatment-naïve DME who participated in the DAVE study (NCT01552408) were included. Ultra-widefield fluorescein angiography images were sent to the Doheny Image Reading Center, where they were montaged and corrected using stereographic projection to adjust for peripheral distortion. Two experienced, independent/masked certified graders manually segmented the NPA and the total visible retinal area (TRA), and computed the NPA and TRA in square millimeters (mm2). The ischemic index (ISI) was calculated. The distributions of NPA and ISI within different retinal zones were correlated with the severity of DME. Results In 40 eyes with treatment-naïve DME (mean age, 55.8 years) visual acuity (VA) (mean 59.6 EDTRS letters) was correlated with central macular thickness (CMT) (mean 536.9 μm, R = −0.418, P = .008) and macular volume (MV) (mean 11.9 mm3, R = −0.449, P = .004). The NPA and ISI among the different retinal zones were significantly different (NPA: P < .001; ISI: P = .005). The NPA and ISI in the midperiphery were negatively associated with CMT (NPA: P = .04; ISI: P = .02). However, the global NPA and ISI for the entire retina were not associated with CMT or MV (P > .05). Conclusion In eyes with DME, the ISI increases with increasing distance from the fovea. The severity of DME does not appear to correlate with global NPA and ISI.

      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.05.024
      Issue No: Vol. 180 (2017)
       
  • Evaluating Structural Progression of Retinitis Pigmentosa After Cataract
           Surgery
    • Authors: Joaquin O. De Rojas; Kaspar Schuerch; Priya M. Mathews; Thiago Cabral; Albert Hazan; Janet Sparrow; Stephen H. Tsang; Leejee H. Suh
      Pages: 117 - 123
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Joaquin O. De Rojas, Kaspar Schuerch, Priya M. Mathews, Thiago Cabral, Albert Hazan, Janet Sparrow, Stephen H. Tsang, Leejee H. Suh
      Purpose To determine whether cataract surgery accelerates disease progression in retinitis pigmentosa (RP). Design Retrospective cohort study. Methods Seventy eyes of 40 patients with RP were categorized as having had phacoemulsification with intraocular lens implantation vs no cataract surgery at a single tertiary-level institution. Spectral-domain optical coherence tomography (SDOCT) was used to measure the ellipsoid zone (EZ) width, which has been demonstrated to be a reliable marker of RP severity, at baseline and throughout follow-up (median 768 days). RP progression was calculated as the loss of EZ width over time for all patients. Additional postoperative data were collected for the cataract surgery group, including preoperative and postoperative best-corrected visual acuity, incidence of macular edema, posterior capsular opacification, epiretinal membrane, and intraocular lens subluxation. Results Multivariable analysis including age, baseline EZ width, mode of inheritance, and cataract surgery status showed that there was no significant difference in RP progression between the cataract surgery and control groups (P = .23). Mode of inheritance was associated with RP progression, with autosomal recessive RP progressing at 148 μm/year and autosomal dominant RP progressing at 91 μm/year (P = .003). Visual acuity improved in almost all eyes that underwent surgery (17/19, 89%) and remained stable in remaining eyes (2/19, 11%). There was a high incidence of postsurgical posterior capsular opacification (18/19, 95%). There were no serious complications, such as lens subluxation or endophthalmitis. Conclusions Our findings suggest that cataract surgery is a safe and effective means of improving visual acuity in RP patients and that it does not seem to be associated with faster disease progression as measured using SDOCT.

      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.05.026
      Issue No: Vol. 180 (2017)
       
  • Outcomes in Autoimmune Retinopathy Patients Treated With Rituximab
    • Authors: Samaneh Davoudi; Nazanin Ebrahimiadib; Cagla Yasa; Damla D. Sevgi; Ramak Roohipoor; Evangelia Papavasilieou; Jason Comander; Lucia Sobrin
      Pages: 124 - 132
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Samaneh Davoudi, Nazanin Ebrahimiadib, Cagla Yasa, Damla D. Sevgi, Ramak Roohipoor, Evangelia Papavasilieou, Jason Comander, Lucia Sobrin
      Purpose To evaluate clinical and ancillary testing, including adaptive optics, outcomes in autoimmune retinopathy (AIR) patients treated with rituximab. Design Retrospective, interventional case series. Methods patients : Sixteen AIR patients treated with rituximab. observation procedures : All patients were treated with a loading and maintenance dose schedule of intravenous rituximab. Visual acuity (VA), electroretinography (ERG), and spectral-domain optical coherence tomography (SDOCT) and visual field (VF) results were recorded. A subset of patients was also imaged using adaptive optics scanning laser ophthalmoscopy (AO-SLO). main outcome measures : Rates of VA change before vs after rituximab initiation were compared with mixed-model linear regression. Results The rate of visual decline was significantly less after rituximab initiation compared with the rate of visual decline prior to rituximab initiation (P = .005). Seventy-seven percent of eyes had stable or improved VA 6 months after rituximab initiation. Amplitudes and implicit times on ERG, mean deviation on VF, central subfield mean thickness, and total macular volume did not decrease to a significant degree over the rituximab treatment period. Six eyes had serial AO-SLO imaging. Cone densities did not change significantly over the treatment period. Conclusion VA was stable or improved in a majority of AIR patients while they were being treated with rituximab. OCT and ERG parameters, as well as AO-SLO cone densities, were stable during treatment. Studies with additional patients and longer follow-up periods are needed to further explore the utility of rituximab in the management of AIR.

      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.04.019
      Issue No: Vol. 180 (2017)
       
  • Trends in Hospitalization and Incidence Rate for Syphilitic Uveitis in the
           United States From 1998 to 2009
    • Authors: Thomas Albini; Natalia F. Callaway; Suzann Pershing; Sean K. Wang; Andrew A. Moshfeghi; Darius M. Moshfeghi
      Pages: 133 - 141
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Thomas Albini, Natalia F. Callaway, Suzann Pershing, Sean K. Wang, Andrew A. Moshfeghi, Darius M. Moshfeghi
      Purpose This study evaluates the annual incidence of syphilitic uveitis in the US and trends in hospital admissions over time. Design Retrospective, longitudinal incidence rate analysis of the National Inpatient Sample (NIS) data from 1998 to 2009. Methods The NIS is a de-identified, random sample dataset of inpatient hospitalizations from 46 states. The number of cases of syphilitic uveitis was defined by (1) International Classification of Diseases, 9th Revision (ICD-9) code for syphilis and uveitis or (2) ICD-9 code for syphilitic uveitis. Annual case count, incidence rate, and trend over time were calculated. Multivariate logistic regression was used to evaluate associated factors for a syphilitic uveitis diagnosis. Results The study included 455 310 286 hospitalizations during a 12-year study period with a mean of 37 942 524 patients annually. Syphilis and uveitis was recorded for 1861 patients (155 annually) and syphilitic uveitis was diagnosed in 204 subjects (average of 17 cases annually). There was no change in the incidence of syphilitic uveitis, using either definition, over the study period (P for trend = .46). The mean annual incidence of syphilis and uveitis was 0.0004%, or 4 per million. Syphilitic uveitis had an annual incidence of 0.000045%, or 0.45 per million. The odds of syphilitic uveitis were lower among women (odds ratio [OR] 0.40, CI 0.28–0.57) and increased with comorbid acquired immunodeficiency syndrome (OR 4.52, CI 3.01–6.79). Conclusions We report the first incidence of syphilitic uveitis in the United States. Fortunately, this remains a rare condition. The results demonstrate no change in the number of inpatient admissions for syphilitic uveitis during the study period.

      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.05.013
      Issue No: Vol. 180 (2017)
       
  • Treat-and-Extend Therapy Using Aflibercept for Neovascular Age-Related
           Macular Degeneration: A Prospective Clinical Trial
    • Authors: Francis Char DeCroos; David Reed; Murtaza K. Adam; David Salz; Omesh P. Gupta; Allen C. Ho; Carl D. Regillo
      Pages: 142 - 150
      Abstract: Publication date: Available online 10 August 2017
      Source:American Journal of Ophthalmology
      Author(s): Francis Char DeCroos, David Reed, Murtaza K. Adam, David Salz, Omesh P. Gupta, Allen C. Ho, Carl D. Regillo


      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.06.002
      Issue No: Vol. 180 (2017)
       
  • Treat-and-Extend Therapy Using Aflibercept for Neovascular Age-related
           Macular Degeneration: A Prospective Clinical Trial
    • Authors: Francis Char DeCroos; David Reed; Murtaza K. Adam; David Salz; Omesh P. Gupta; Allen C. Ho; Carl D. Regillo
      Pages: 142 - 150
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Francis Char DeCroos, David Reed, Murtaza K. Adam, David Salz, Omesh P. Gupta, Allen C. Ho, Carl D. Regillo
      Purpose To determine the efficacy and durability of aflibercept used in a treat-and-extend (TAE) regimen for neovascular age-related macular degeneration (NVAMD). Design Multicenter, prospective, open label, noncomparative, interventional study. Methods Forty eyes of 40 patients with treatment-naïve NVAMD were managed with a TAE regimen of intravitreal aflibercept. The main endpoints were the change in mean and median best-corrected visual acuity from baseline at years 1 and 2. Other endpoints included mean number of annual injections and treatment intervals. Results Thirty-five (87.5%) and 31 patients (77.5%) completed year 1 and year 2, respectively. The mean letter gain was 7.2 (P < .001) and 2.4 (P = .269) letters at 1 and 2 years, respectively, from a mean baseline of 58.9 letters (20/63 Snellen equivalent). The median visual gain was 11.5 and 7.5 letters at 1 and 2 years, respectively, from a median baseline of 59.0 letters (20/63 Snellen equivalent). The mean number of injections was 8.0 and 6.5 during the first and second year, respectively. Twelve-week or longer treatment intervals were used in 35% and 38% of patients during the first- and second-year time points, respectively. Conclusion Intravitreal aflibercept TAE therapy led to significant visual improvement in eyes with NVAMD at 1 year, with some loss in the visual gains at the end of year 2 that was not related to loss of exudative control. TAE therapy with aflibercept is a rational strategy to reduce treatments and clinic evaluations over 2 years with satisfactory outcomes.

      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.06.002
      Issue No: Vol. 180 (2017)
       
  • Risk Factors for Rapid Glaucoma Disease Progression
    • Authors: Thomas Chun Wai Chan; Chandra Bala; Anna Siu; Fiona Wan; Andrew White
      Pages: 151 - 157
      Abstract: Publication date: August 2017
      Source:American Journal of Ophthalmology, Volume 180
      Author(s): Thomas Chun Wai Chan, Chandra Bala, Anna Siu, Fiona Wan, Andrew White
      Purpose To determine the intraocular and systemic risk factor differences between a cohort of rapid glaucoma disease progressors and nonrapid disease progressors. Design Retrospective case-control study. Methods Setting : Five private ophthalmology clinics. Study Population : Forty-eight rapidly progressing eyes (progression ≥1 dB mean deviation [MD]/year) and 486 non–rapidly progressing eyes (progression <1 dB MD/year). Patients were eligible if they had a diagnosis of glaucoma from their ophthalmologist and if they had greater than or equal to 5 Humphrey visual fields (24-2) conducted. Patients were excluded if their sequential visual fields showed an improvement in MD or if they had greater than 5 dB MD variation in between visits. Patients with obvious neurologic fields were excluded. Observation Procedure : Clinical and demographic data (age, sex, central corneal thickness [CCT], intraocular pressure [IOP], refraction, medications), as well as medical, surgical, and ocular histories, were collected. Main Outcome Measures : Risk factor differences between the cohorts were measured using the independent t test, Wald χ2, and binomial regression analysis. Results Rapid progressors were older, had significantly lower CCT and baseline IOPs, and were more likely to have pseudoexfoliation, disc haemorrhages, ocular medication changes, and IOP-lowering surgery. They also had significantly higher rates of cardiovascular disease and hypotension. Subjects with cardiovascular disease were 2.33 times more likely to develop rapidly progressive glaucoma disease despite significantly lower mean and baseline IOPs. Conclusion Cardiovascular disease is an important risk factor for rapid glaucoma disease progression irrespective of IOP control.

      PubDate: 2017-08-05T00:22:00Z
      DOI: 10.1016/j.ajo.2017.06.003
      Issue No: Vol. 180 (2017)
       
  • Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Methods
           and Screening Results
    • Authors: Lisa Hark; Jay Katz Jonathan Myers Michael Waisbourd Deiana Johnson
      Abstract: Publication date: September 2017
      Source:American Journal of Ophthalmology, Volume 181
      Author(s): Lisa A. Hark, L. Jay Katz, Jonathan S. Myers, Michael Waisbourd, Deiana Johnson, Laura T. Pizzi, Benjamin E. Leiby, Scott J. Fudemberg, Anand V. Mantravadi, Jeffrey D. Henderer, Tingting Zhan, Jeanne Molineaux, Vance Doyle, Meskerem Divers, Christine Burns, Ann P. Murchison, Shae Reber, Arthur Resende, Thien Dan V. Bui, Jane Lee, John E. Crews, Jinan B. Saaddine, Paul P. Lee, Louis R. Pasquale, Julia A. Haller
      Purpose To describe methodology and screening results from the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. Design Screening program results for a prospective randomized clinical trial. Methods Individuals were recruited who were African-American, Hispanic/Latino, or Asian over age 40 years; white individuals over age 65 years; and any ethnicity over age 40 years with a family history of glaucoma or diabetes. Primary care offices and Federally Qualified Health Centers were used for telemedicine (Visit 1). Two posterior fundus photographs and 1 anterior segment photograph were captured per eye in each participant, using a nonmydriatic, autofocus, hand-held fundus camera (Volk Optical, Mentor, Ohio, USA). Medical and ocular history, family history of glaucoma, visual acuity, and intraocular pressure measurements using the ICare rebound tonometer (ICare, Helsinki, Finland) were obtained. Images were read remotely by a trained retina reader and a glaucoma specialist. Results From April 1, 2015, to February 6, 2017, 906 individuals consented and attended Visit 1. Of these, 553 participants were female (61.0%) and 550 were African-American (60.7%), with a mean age of 58.7 years. A total of 532 (58.7%) participants had diabetes, and 616 (68%) had a history of hypertension. During Visit 1, 356 (39.3%) participants were graded with a normal image. Using image data from the worse eye, 333 (36.8%) were abnormal and 155 (17.1%) were unreadable. A total of 258 (28.5%) had a suspicious nerve, 62 (6.8%) had ocular hypertension, 102 (11.3%) had diabetic retinopathy, and 68 (7.5%) had other retinal abnormalities. Conclusion An integrated telemedicine screening intervention in primary care offices and Federally Qualified Health Centers detected high rate of suspicious optic nerves, ocular hypertension, and retinal pathology.

      PubDate: 2017-08-14T00:38:04Z
       
  • Diagnostic Capability of Peripapillary 3D Retinal Nerve Fiber Layer Volume
           for Glaucoma Using Optical Coherence Tomography Volume Scans
    • Authors: Ziad Khoueir; Firas Jassim; Linda Yi-Chieh Poon; Edem Tsikata; Geulah S. Ben-David; Yingna Liu; Eric Shieh; Ramon Lee; Rong Guo; Georgia Papadogeorgou; Boy Braaf; Huseyin Simavli; Christian Que; Benjamin J. Vakoc; Brett E. Bouma; Johannes de Boer; Teresa C. Chen
      Abstract: Publication date: Available online 12 August 2017
      Source:American Journal of Ophthalmology
      Author(s): Ziad Khoueir, Firas Jassim, Linda Yi-Chieh Poon, Edem Tsikata, Geulah S. Ben-David, Yingna Liu, Eric Shieh, Ramon Lee, Rong Guo, Georgia Papadogeorgou, Boy Braaf, Huseyin Simavli, Christian Que, Benjamin J. Vakoc, Brett E. Bouma, Johannes de Boer, Teresa C. Chen
      Purpose To determine the diagnostic capability of peripapillary 3-dimensional (3D) retinal nerve fiber layer (RNFL) volume measurements from spectral domain optical coherence tomography (OCT) volume scans for open angle glaucoma (OAG). Design Assessment of diagnostic accuracy. Methods Setting: Academic clinical setting. Study population: 180 patients (113 OAG and 67 normal subjects). Observation procedures: One eye per subject was included. Peripapillary 3D RNFL volumes were calculated for global, quadrant, and sector regions, using four different sized annuli. Peripapillary 2D RNFL thickness circle scans were also obtained. Main outcome measures: Area under the receiver operating characteristic curve (AUROC) values, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios. Results Among all 2D and 3D RNFL parameters, best diagnostic capability was associated with inferior quadrant 3D RNFL volume of the smallest annulus (AUROC curve value 0.977). Otherwise, global 3D RNFL volume AUROC curve values were comparable to global 2D RNFL thickness AUROC curve values for all 4 annuli sizes (p values: 0.0593 to 0.6866). When comparing the 4 annuli sizes for global RNFL volume, the smallest annulus had the best AUROC curve values (p values: 0.0317 to 0.0380). The smallest sized annulus may have the best diagnostic potential partly due to having no areas excluded for being larger than the 6x6 mm square scanned region. Conclusion Peripapillary 3D RNFL volume showed excellent diagnostic performance for detecting glaucoma. Peripapillary 3D RNFL volume parameters have the same or better diagnostic capability compared to peripapillary 2D RNFL thickness measurements, although differences were not statistically significant.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.08.001
       
  • Early Trabeculotomy Ab Externo in Treatment of Sturge-Weber Syndrome
    • Authors: Yue Wu; Rujing Yu; Di Chen; Li Xu; Li Zhu; Mao Li; Chunyu Guo; Ping Gu; Xiaoxi Lin; Wenyi Guo
      Abstract: Publication date: Available online 12 August 2017
      Source:American Journal of Ophthalmology
      Author(s): Yue Wu, Rujing Yu, Di Chen, Li Xu, Li Zhu, Mao Li, Chunyu Guo, Ping Gu, Xiaoxi Lin, Wenyi Guo
      Purpose To evaluate the intermediate-term efficacy and safety of trabeculotomy in infant Sturge-Weber syndrome (SWS). Design Retrospective cohort study. Methods All SWS-induced glaucoma patients less than 12 months of age who underwent trabeculotomy at our Ophthalmology Department from August 2011 to March 2017 were reviewed. Baseline demographics, intraocular pressure (IOP), cup-to-disc ratio (C/D) and cornea diameters were noted before surgery. The IOP, success probabilities and medication usage were recorded during follow-up until the last visit. Results Overall, 34 eyes (32 patients) were included, with a median surgery age of 3 months and a median follow-up time of 15.5 months. The mean preoperative IOP, asymmetry between two eyes, cornea diameter and median C/D were 21.5±6.6 mmHg, 10.1±4.9 mmHg, 12.6±0.7 mm and 0.65 [interquartile range (IQR): 0.55, 0.80], respectively. The IOP was significantly reduced from the preoperative baseline at 1 week, 3 months, 6 months, 1 year and 2 years after the surgery (p<0.05). At the last follow-up, the cumulative proportions of overall and complete success were 86.6% and 66%, respectively. Complications included a transient shallow anterior chamber. Thirty of the 34 eyes had intraoperative hyphema, 27 of which lasted less than 3 days. No other complications were noted during the follow-up. Conclusions Compared to previous studies with a later diagnosis of glaucoma in SWS patients, better outcomes were achieved with an early diagnosis of glaucoma in SWS patients. Early trabeculotomy ab externo was safe and led to good intermediate-term surgical outcomes for early-onset glaucoma in SWS patients. Higher preoperative IOP and cornea edema were associated with a greater risk of surgery failure.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.08.002
       
  • En Face Optical Coherence Tomography Analysis to Assess the Spectrum of
           Perivenular Ischemia and Paracentral Acute Middle Maculopathy in Retinal
           Vein Occlusion
    • Authors: David McLeod
      Abstract: Publication date: Available online 9 August 2017
      Source:American Journal of Ophthalmology
      Author(s): David McLeod


      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.06.037
       
  • Treat-and-Extend Therapy Using Aflibercept for Neovascular Age-Related
           Macular Degeneration: A Prospective Clinical Trial
    • Authors: Dan Călugăru; Mihai Călugăru
      Abstract: Publication date: Available online 8 August 2017
      Source:American Journal of Ophthalmology
      Author(s): Dan Călugăru, Mihai Călugăru


      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.07.017
       
  • Optical Coherence Tomography Angiography of the Peripapillary Retina in
           Primary Angle-Closure Glaucoma
    • Authors: Shunhua Zhang; Chan Wu; Liang Liu; Yali Jia; Yao Zhang; Yang Zhang; Hua Zhang; Yong Zhong; David Huang
      Abstract: Publication date: Available online 7 August 2017
      Source:American Journal of Ophthalmology
      Author(s): Shunhua Zhang, Chan Wu, Liang Liu, Yali Jia, Yao Zhang, Yang Zhang, Hua Zhang, Yong Zhong, David Huang
      Purpose To measure the change of peripapillary retinal vessel density (VD) in eyes with a history of acute primary angle closure glaucoma (PACG). Design Case-control study. Methods Twenty-one consecutive Chinese patients with history of unilateral acute PACG were enrolled. Eyes with acute PACG constituted the case group, while the contralateral eyes without attack constituted the control. All patients underwent ophthalmic examinations including best-corrected visual acuity, intraocular pressure, and visual field (VF). Spectral-domain optical coherence tomography (SD-OCT) was used to obtain both structural OCT and OCT angiography (OCTA). Structural OCT scans provided thickness measurements of the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC). OCTA was used to measure all-plexus peripapillary retinal VD. Results In unaffected eyes, a dense microvascular network surrounded the disc on all-plexus retinal OCTA. The vascular network was visibly attenuated and focal capillary dropout was evident in acute PACG eyes. The peripapillary VD in acute PACG eyes was 66.6±17.3% (mean±standard deviation), which was significantly (p<0.01) reduced compared to 87.2±8.6% in the unaffected eyes. In acute PACG eyes, peripapillary retina VD was positively correlated with RNFL and GCC thicknesses (p<0.001 each) and negatively correlated with VF mean deviation (p=0.002) and cup-to-disc ratio (p=0.0064). In unaffected eyes, there were no correlations between peripapillary retina VD and glaucoma-related parameters. Conclusions In acute PACG eyes, peripapillary retinal VD decreased significantly compared with the contralateral unaffected eyes. Peripapillary retinal VD was significantly correlated with other glaucomatous changes.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.07.024
       
  • Sensitivity and Specificity of Laser-Scanning In Vivo Confocal Microscopy
           for Filamentous Fungal Keratitis: Role of Observer Experience
    • Authors: Siamak Sabour; Fariba Ghassemi
      Abstract: Publication date: Available online 7 August 2017
      Source:American Journal of Ophthalmology
      Author(s): Siamak Sabour, Fariba Ghassemi


      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.06.035
       
  • Performance and Safety of a New Ab Interno Gelatin Stent in Refractory
           Glaucoma at 12 Months
    • Authors: Davinder S. Grover; William J. Flynn; Kent P. Bashford; Richard A. Lewis; Yi-Jing Duh; Rupali S. Nangia; Barbara Niksch
      Abstract: Publication date: Available online 5 August 2017
      Source:American Journal of Ophthalmology
      Author(s): Davinder S. Grover, William J. Flynn, Kent P. Bashford, Richard A. Lewis, Yi-Jing Duh, Rupali S. Nangia, Barbara Niksch
      Purpose To evaluate the intraocular pressure (IOP)-lowering performance and safety of an ab interno gelatin stent (XEN® 45 Gel Stent, Allergan plc), a minimally invasive glaucoma surgery device, in refractory glaucoma. Design Single-arm, open-label, multicenter clinical study. Methods Following mitomycin pretreatment, the stent was placed ab interno in patients who failed prior filtering/cilioablative procedure or had uncontrolled IOP on maximum-tolerated medical therapy, with medicated IOP ≥20 and ≤35 mmHg and visual field mean deviation ≤−3 dB. Primary performance outcomes: patients (%) achieving ≥20% IOP reduction from baseline on the same or fewer medications and mean IOP change from baseline at month 12. Procedure-related complications and ocular adverse events (AEs) were assessed. Results Sixty-five patients were implanted (intent-to-treat/safety population). At 12 months, 75.4% (46/61; observed data) reported ≥20% IOP lowering from baseline on the same or fewer medications. Mean IOP change from baseline was −9.1 mmHg (95% CI: −10.7, −7.5) (n=52; observed data) at 12 months, excluding patients with missing data (n=4) and those requiring a glaucoma-related secondary surgical intervention (n=9). Mean medication count decreased from 3.5 (baseline) to 1.7 (12 months). No intraoperative complications or unexpected postoperative AEs were reported. Most AEs were mild/moderate; common AEs included needling (without sight-threatening complications), non-persistent loss of best-corrected visual acuity, and transient hypotony (requiring no surgical intervention). Conclusions The gelatin stent reduced IOP and medication use without raising unexpected safety concerns, offering a minimally invasive surgical option for refractory glaucoma patients.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.07.023
       
  • An Analysis of Medicare Reimbursement to Ophthalmologists: Years 2012 to
           2013
    • Authors: Everett Han; Shivani Baisiwala; Atul Jain; M. Kate Bundorf; Suzann Pershing
      Abstract: Publication date: Available online 4 August 2017
      Source:American Journal of Ophthalmology
      Author(s): Everett Han, Shivani Baisiwala, Atul Jain, M. Kate Bundorf, Suzann Pershing
      Purpose To analyze trends in utilization and payment of ophthalmic services in the Medicare population for years 2012 and 2013. Design Retrospective, cross-sectional study. Methods A retrospective cross-sectional observational analysis was performed using publicly-available Medicare Physician and Other Supplier aggregate file and the Physician and Other Supplier Public Use File (PUF). Variables analyzed included aggregate beneficiary demographics, Medicare payments to ophthalmologists, ophthalmic medical services provided, and the most common Medicare-reimbursed ophthalmic services. Results In 2013, total Medicare Part B reimbursement for ophthalmology was $5.8 billion, an increase of 3.6% from the previous year. From 2012 to 2013, the total number of ophthalmology services rendered increased by 2.2%, while average dollar amount reimbursed per ophthalmic service decreased by 5.4%. The top 5 highest reimbursed services accounted for 85% of total ophthalmic Medicare payments in 2013, an 11% increase from 2012. During 2013, drug reimbursement represented 32.8% of the total Medicare payments to ophthalmologists. Ranibizumab and aflibercept alone accounted for 95% of the entire $1.9 billion in drug reimbursements ophthalmologists in 2013. Conclusion Medicare Part B reimbursement for ophthalmologists was primarily driven by use of anti-Vascular Endothelial Growth Factor (anti-VEGF) injections from 2012 to 2013. Of the total drug payments to ophthalmologists, biologic anti-VEGF agents ranibizumab and aflibercept accounted for 95% of all drug reimbursement. This is in contrast to other specialties in which drug reimbursement represented only a small portion of Medicare reimbursement.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.07.022
       
  • Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation
           and Cross-linking in Pediatric Keratoconus
    • Authors: Elias F. Jarade; Youssef Abdelmassih; Sylvain El-Khoury
      Abstract: Publication date: Available online 4 August 2017
      Source:American Journal of Ophthalmology
      Author(s): Elias F. Jarade, Youssef Abdelmassih, Sylvain El-Khoury


      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.07.018
       
 
 
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